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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802133
Report Date: 01/24/2025
Date Signed: 01/24/2025 12:24:10 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/15/2025 and conducted by Evaluator Emily Peraldi
COMPLAINT CONTROL NUMBER: 29-AS-20250115113432
FACILITY NAME:ROSE GARDEN MANOR IVFACILITY NUMBER:
565802133
ADMINISTRATOR:SORATORIO, AMALIAFACILITY TYPE:
740
ADDRESS:745 BERKSHIRE PLACETELEPHONE:
(805) 246-5148
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:6CENSUS: 6DATE:
01/24/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Amalia Soratorio, Licensee TIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Staff did not allow resident to have visitors while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Emily Peraldi along with Quality Assurance Specialist (QAS) Tri-Counties regional center Katy Robison conducted an unannounced initial complaint visit to this facility. At 9:30 a.m., the LPA met with staff and explained the reason for the visit. At 10:11 a.m., the Licensee arrived at the facility.

At 9:56 a.m., the LPA along with staff conducted a physical plant tour. Starting at 9:59 a.m., the LPA conducted interviews with the Licensee and one (1) staff, and one (1) resident. At 10:45 a.m., the LPA obtained copies of pertinent documents.

Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 29-AS-20250115113432
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ROSE GARDEN MANOR IV
FACILITY NUMBER: 565802133
VISIT DATE: 01/24/2025
NARRATIVE
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Regarding the allegation: Staff did not allow resident to have visitors while in care. On 1/15/2025, the Department received a complaint alleging facility staff is restricting Resident #1 (R1) visitation from Individual #1 (I1). It was alleged that I1 attempted to visit R1 on Sunday January 12, 2025, and that staff did not allow I1 to see R1 as they told I1 that R1 was not home. Per interview with the Licensee, it was revealed that facility staff did not restrict I1 from visiting R1 instead I1 came to the facility while R1 was out in the community. The LPA reviewed R1’s daily notes and the facility’s sign in and out sheet and confirmed that R1 was out in the community on January 12, 2025. The Licensee stated that residents are always allowed visitors and that she has not restricted R1 from seeing I1. The LPA reminded the Licensee that facility staff cannot restrict visitation unless there are legal documents such as a restraining order in place. The LPA reminded the Licensee to keep a copy of such legal documents in resident’s files. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was issued.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2